Quantitative Analysis of Vortical Blood Flow in the Thoracic Aorta Using 4D Phase Contrast MRI

Introduction Phase contrast MRI allows for the examination of complex hemodynamics in the heart and adjacent great vessels. Vortex flow patterns seem to play an important role in certain vascular pathologies. We propose two-and three-dimensional metrics for the objective quantification of aortic vortex blood flow in 4D phase contrast MRI. Materials and Methods For two-dimensional vorticity assessment, a standardized set of 6 regions-of-interest (ROIs) was defined throughout the course of the aorta. For each ROI, a heatmap of time-resolved vorticity values (omega) over right arrow = del(nu) over right arrow was computed. Evolution of minimum, maximum, and average values as well as opposing rotational flow components were analyzed. For three-dimensional analysis, vortex core detection was implemented combining the predictor-corrector method with lambda(2) correction. Strength, elongation, and radial expansion of the detected vortex core were recorded over time. All methods were applied to 4D flow MRI datasets of 9 healthy subjects, 2 patients with mildly dilated aorta, and 1 patient with aortic aneurysm. Results Vorticity quantification in the 6 standardized ROIs enabled the description of physiological vortex flow in the healthy aorta. Helical flow developed early in the ascending aorta (absolute vorticity = 166.4 +/- 86.4 s(-1) at 12% of cardiac cycle) followed by maximum values inmid-systole in the aortic arch (240.1 +/- 45.2 s(-1) at 16%). Strength, elongation, and radial expansion of 3D vortex cores escalated in early systole, reaching a peak inmid systole (strength = 241.2 +/- 30.7 s(-1) at 17%, elongation = 65.1 +/- 34.6 mm at 18%, expansion = 80.1 +/- 48.8 mm(2) at 20%), before all three parameters similarly decreased to overall low values in diastole. Flow patterns were considerably altered in patient data: Vortex flow developed late inmid/end-systole close to the aortic bulb and no physiological helix was found in the aortic arch. Conclusions We have introduced objective measures for quantification of vortical flow in 4D phase contrast MRI. Vortex blood flow in the thoracic aorta could be consistently described in all healthy volunteers. In patient data, pathologically altered vortex flow was observed.